Under-reporting of AD in death certificates is an old story, dating back to the time Alzheimer disease was considered a presenile dementia. In our study of early-onset familial AD in Italy (1), affected members of the kindred, who generally died in their fifties, were uniformly recorded with "broncho-pneumonia" as the cause of death (Italian law or custom at the time allowed only one cause of death to be mentioned). During life, affected family members mostly received a diagnosis of "General Paralysis of the Insane." As late as 1973, after having examined a first cousin of our histologically proven AD proband, who displayed identical symptoms, the senior psychiatrist in charge, to whom I was explaining the interest of this case for research on AD, answered, "Thank you, my dear colleague, for bringing to my attention this most interesting instance of hereditary GPI."

References:
1. Foncin JF, Salmon D, Supino-Viterbo V, Feldman RG, Macchi G, Mariotti P, Scoppetta C, Caruso G, Bruni AC. Démence présénile d'Alzheimer transmise dans une famille étendue. Rev Neurol (Paris). 1985;141(3):194-202. Abstract

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